Multiple Sclerosis Centers of Excellence
Multiple Sclerosis Centers of Excellence Research and Development
The MS Centers of Excellence facilitate research to improve the understanding of MS among Veterans with MS. We advance forward the VA’s research mission by providing a structure and environment that facilitates MS laboratory, clinical, and epidemiologic and health services research. We also provide an environment for the incubation of ideas, and provide a structured network to advance research quickly. Our local and national multi-site trials enhance collaboration among VA medical facilities and increase the participation of Veterans in research activities. We also provide mentoring for VA Career Development Grants and National Institute of Health Awards.
MSCoE West currently has over $20 million of research funding from various sources including the Veterans Affairs Rehabilitation Research and Development (VA RR&D) Service, National Institutes of Health (NIH), National Multiple Sclerosis Society (NMSS), and private industry. In addition, MSCoE West conducts several unfunded research and scholarly activities. To learn about VA MS researchers and research, visit our VA MS Researchers page.
Notable Opinions Published (2016-2017)
Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness
MSCoE Authors: Bourdette, Whitham
US health insurance is an obstacle to disease-modifying treatments in MS
MSCoE Author: Bourdette
Rituximab for treating MS: Off-label but on target
MSCoE Author: Bourdette
Systematic Reviews (2016-2017)
Mental Health Comorbidity in MS: Depression, Anxiety, and Bipolar Disorder
MSCoE Authors: Turner, Haselkorn, Sloan
Conclusions: This review examines current evidence surrounding three mental health issues of particular relevance to MS: depression, anxiety, and bipolar disorder.
Important Research Findings (2016-2017)
The contemporary spectrum of MS misdiagnosis: A multicenter study
MSCoE Authors: Solomon*, Bourdette, Spain, Cameron, Kim, Whitham (*prior MSCoE OAA fellow)
Conclusions: Misdiagnoses of MS can be of long duration, results in unnecessary exposure to disease-modifying therapy with associated morbidities, and is often due to an overreliance on MRI abnormalities in patients with nonspecific symptoms.
Sex-dependent treatment of chronic EAE with partial MHC class II constructs
MSCoE Authors: Offner, Bourdette, Vandenbark
Conclusions: This laboratory studies findings will assist in the design of future clinical trials using pMHC for treatment of progressive MS.
Methylphenidate is likely less effective than placebo for improving imbalance, walking, and fatigue in people with MS
MSCoE Author: Cameron
Conclusions: A pilot randomized controlled clinical trial of methylphenidate in MS that found that, at doses of 10 mg bid to 30 mg bid, methylphenidate is likely less effective than placebo for improving imbalance, walking, and fatigue in people with MS.
Improving fatigue and depression in individuals with MS using telephone-administered physical activity counseling
MSCoE Authors: Turner, Hartoonian, Sloan, Hughes, Haselkorn
Conclusions: This pilot clinical trial found that the telephone counseling intervention improved physical activity, fatigue, and depression in people with MS.
Postural Motor Learning Deficits in People With MS in Spatial but Not Temporal Control of Center of Mass
MSCoE Authors: Cameron, Horak
Conclusions: People with MS have the capacity to improve use of a feed-forward postural strategy with practice and retain the learned behavior for temporal not spatial control of CoM, despite their significant postural response impairments.
Immunotherapies and New Teatments for Remyelination
Lipoic acid in secondary progressive MS: A randomized controlled pilot trial*
MSCoE Author: Spain
Conclusions: Lipoic acid demonstrated a 68% reduction in annualized PCBV and suggested a clinical benefit in SPMS while maintaining favorable safety, tolerability, and compliance over 2 years.
*This two-year double blind placebo controlled trial of lipoic acid in SPMS was funded by a VA RR&D career development award. Results from the study were featured at the 2016 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting. Results of the study formed the basis for a successful application to VA RR&D Service for Merit award funding of a multi-center placebo controlled trial of lipoic acid powered to detect an effect on walking speed.
Thyroid Hormone for Remyelination in MS: A Safety and Dose Finding Study*
MSCoE Researchers: Cameron, Bourdette
*This dose-finding and safety study of escalating doses of thyroid hormone was completed in 2017 and a Phase II study is being planned.
Patient Outcomes and Patient Care
Predicting medication adherence in multiple sclerosis using telephone-based home monitoring
MSCoE Authors: Turner, Haselkorn
Conclusions: Brief, telephone-based assessments of adherence expectations may represent an easy and efficient method for monitoring medication use among individuals with MS.
Assistive Device Training for Functional Mobility and Connectivity in MS*
MSCoE Researcher: Cameron
Conclusions: People with MS who used a walking aid at baseline and had fallen in the past year - who received six weekly, one-on-one, 40-minute, task-oriented walking aid training sessions with a physical therapist - were less likely to fall in the 3 months after the training than if they had received standard care. In addition, there were trends for those in the intervention group walking more, sitting less, and having significant changes in resting state fMRI.
*Results from this pilot VA Small Projects in Rehabilitation (SPiRE) study are the basis for pursing funding for a multi-site, full-scale trial of this intervention.
Sleep and its associations with perceived and objective cognitive impairment in individuals with MS
MSCoE Authors: Hughes, Haselkorn, Lovera*, Bourdette, Cameron, Turner (*prior MSCoE OAA fellow)
Conclusions: Self-reported sleep is significantly and independently related to perceived cognitive impairment in MS. Interventions focused on improving sleep may help improve perceived cognitive function and quality of life in this population; however, the impact of improved sleep on objective cognitive function requires further investigation.
Association Between Sleep Problems and Perceived Cognitive Dysfunction Over 12 Months in Individuals with MS*
MSCoE Authors: Hughes, Turner
Conclusions: For individuals with MS and depression, fatigue, or pain, self-reported sleep problems are related to perceived cognitive dysfunction, and that fatigue impact accounts for part of this relationship.
*This line of investigation formed the basis for a successful K23 application for Dr. Hughes to pursue web-based adaptations of Cognitive Behavior Therapy for insomnia for individuals with MS.
A group-delivered self-management program reduces spasticity in people with MS: A randomized, controlled pilot trial*
MSCoE Authors: Hugos, Bourdette
Conclusions: Participation in the program, followed by 4 weeks of home stretching, improved self-reported impact of spasticity more than usual care and home stretching. Encouraging improvements in fatigue and depression symptoms.
*This pilot, phase I, placebo controlled study has led to a VA RR&D Merit Review funded study currently under IRB review.
An Empirical Investigation of a Biopsychosocial Model of Pain in Multiple Sclerosis
MSCoE Authors: Turner, Hartoonian
Conclusions: Results highlight the importance of targeting interventions toward improving coping skills and social support within the context of pain and MS.
Epidemiology (Military Service)
MS in gulf war era veterans. 2. Military deployment and risk of MS in the first gulf war
MSCoE Authors: Wallin, Culpepper, Maloni, Haselkorn
Conclusion: Military deployment to GW1 was not a risk factor for developing MS.
The Gulf War era MS cohort: age and incidence rates by race, sex and service
MSCoE Authors: Wallin, Culpepper, Maloni, Haselkorn
Conclusions: Females of all races have incidence rates for MS some three times those of their male counterparts and that among these groups, Blacks have the highest and others (probably including Hispanics) the lowest incidence rates regardless of sex or service.
MS in US veterans of the Vietnam era and later military service: race, sex, and geography
MSCoE Author: Wallin
Conclusions: This report has shown that MS risk has changed in the US veteran population, and thus presumably in all Americans, over a single generation.
MSCoE MS Data Repository
The MS Centers of Excellence maintain a national MS Data Repository as a part of our mission. The MSCoE repository contains the VHA medial data of every patient diagnosed with MS since 1999; over 46,000 unique and deidentified cases. It is the largest collection of information on men with MS in the world. Men comprise more than 80% of the repository with an average age in the mid 50's.
Repository data has been used in our studies of exercise, smoking, obesity, pain, spasticity, falls, access to specialty care, disease modifying therapies, complementary and alternative medicine, telehealth, rural medicine, cost of care, and causes of death among VHA patients with MS. MSCoE also uses it to contact patients and caregivers who are within driving distance of upcoming MSCoE educational events, as well as for the delivery of our MS Veteran newsletter.
If you are interested in using the MS Data Repository, contact Steven.Leipertz@va.gov for details.